Alternative No More

The results of a 1991 telephone survey by David Eisenberg, MD, woke up the health care community. Thirty-six percent of the respondents said they'd been to an alternative provider in 1990, a far higher use of unconventional therapies than had been previously reported.¹ Expenditures for alternative therapies in 1990 was $13.7 billion, $10.3 of which was paid out-of-pocket. These figures were all the more astounding, because the out-of-pocket expenditures for 1990 for hospitalizations in the U.S. were $12.8 billion.

As soon as the medical profession recovered from the shock of the Eisenberg numbers, the scramble was on to get in on the trend.

Now, seven years later, Dr. Eisenberg, et al., have updated the survey.² The numbers for alternative therapy use in 1997 show the trend is still growing.

• The percentage of the U.S. population who use alternative care increased from 33.8% (60 million people) to 42.1% (83 million people).


• The probability of an alternative care user seeing an alternative practitioner increased from 36.3% (22 million people) to 46.3% (39 million people).


• The increase in annual visits to alternative practitioners grew from 427 million to 629 million, nearly double the number of visits to all primary care physicians (386 million).


• Of the 44% of the population that regularly take prescription drugs, 18.4% also take at least one herbal product, a high-dose vitamin, or both.


• The estimated expenditures for alternative care providers increased from $14.6 billion to $21.2 billion (another estimate is as high as $32.7 billion).


• The percentage of alternative care users who discussed their use with their MD dropped slightly from 39.8% to 38.5%.

Looking at chiropractic usage, the changes were not as dramatic, but still quite positive.

• The percentage of population who used chiropractic in the past year grew from 10.1% to 11%.


• The average number of visits per patient dropped, but the total number of visits (per 1,000 population) increased sharply from 904.8 to 969.1, almost one visit per person.


• The conditions most often responsible for a chiropractic visit also increased (see chart below):

Why Do Patients Go to the Chiropractor?
Condition	% Reporting Condition		% with Condition Who Saw Provider
	1990	1997	1990	1997
Back Problems	19.9%	24.0%	19.5%	30.1%
Arthritis	15.9%	16.6%	7.6%	10.0%
Headaches	13.2%	12.9%	6.3%	13.3%
Neck Problems	no data	12.1%	no data	37.5%
Sprains/Strains	13.4%	10.8%	9.6%	10.3%

The trend is clear. The authors' conclusions said it all:

"Alternative medicine use and expenditures increased substantially between 1990 and 1997, attributable primarily to an increase in the proportion of the population seeking alternative therapies, rather than increased visits per patient."

This study begs the question about what term should be used to describe the nonmedical care ("alternative," "complimentary," etc.). As this trend continues, the form of care most in danger of being labelled alternative could be medicine.

The Eisenberg paper is a must read for every doctor of chiropractic. For your convenience, we've put a link on www.chiroweb.com that will take you directly to the Eisenberg paper on the AMA's website.

References

1. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the U.S. -- prevalence, costs and patterns of use. N Engl J Med 1993;328:246-52
2. Eisenberg DM, Davis RB, Ettner SL, Appel S, Wilkey S, Rompay MV, Kessler RC. Trends in alternative medicine use in the United States, 1990-1997. JAMA 1998;280:1569-1575.